The Outlook for 2016

by Will LockwoodAs the year winds down, it’s time for our annual look at what’s ahead for pharmacy technology. We focused this year on finding out how vendors see the dynamic between technology and critical areas of current pharmacy practice.

Pharmacy performance and patient outcomes come right at the top of the list. We also looked inside those areas at sync and adherence programs, as well as the data and process management needs to really ramp up performance. Specialty pharmacy is another area where we gauge the trends and look at where technology is going to need to be for pharmacies expecting to operate in this market. Finally, we assess regulations that will have an impact, and find out just where pharmacies should consider putting investment dollars in 2016.

Programs for Performance

Pharmacy performance is a topic that’s top of mind these days, with Part D plans looking to preferred networks that are composed of high-performance pharmacies. And when you talk about performance, it’s really impossible not to talk about technology and the central role it plays providing the process support, as well as the measurements and reporting, that will allow pharmacies to make the case for both how their efforts are creating better outcomes and for, ultimately, their inclusion in these networks.

Pharmacy staff should expect software to provide the tools they need to support their performance-oriented efforts, scheduling and documenting patient consultations and assessments and running medication synchronization and refill reminder programs, according to CarePoint’s Rachel Cupp. Innovation’s Doyle Jensen offers a few more features he sees as critical for helping pharmacies improve their star ratings and provide better care, including follow-up scheduling tools, patientto- pharmacist communication tools, and analytic-based success/failure predictors.

Pharmacies will want to pay careful attention to star ratings, notes Ateb’s Frank Sheppard. “As higher star ratings become more difficult to achieve,” he explains, “pharmacies will find technology that guides them through high-level patient engagement to be most valuable.” Sheppard sees opportunity here, as new quality measures will offer pharmacies the chance to demonstrate to plans the ability to positively impact the Healthcare Effectiveness Data and Information Set (HEDIS) measures. This should, in turn, accelerate opportunities for pharmacies in pay-for-performance models.

Leveraging automated services saves time that pharmacy technicians and pharmacists can then use to engage and counsel patients, notes voiceTech’s Jeanne Van Dyke. She sees med sync as an excellent example of an area where the application of technology allows pharmacists to both offer a high-level, performance-oriented program and keep time free for a more organic, personal level of interaction with their patients. “That will improve customer loyalty and medication adherence, which will result in improved patient outcomes,” says Van Dyke. And, of course, better outcomes are central to pharmacy performance.

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Pharmacists are going to be focusing on effective and easy methods to document interventions and savings for patients, notes SoftWriters’ Heather Martin. This is information crucial in demonstrating pharmacy value, and another area where applying the right technology will mean that pharmacy staff have the time to create and use this data without shortchanging other areas of need. Overall the central concept here is that pharmacies are going to need technology that helps them address growing demands on time, and position themselves for opportunity rather than simply maintaining the status quo. As Health Business Systems’ Marty Spellman puts it, “We see more pharmacies that think they have a good solution for adherence and medication management, but they don’t have the bandwidth to measure them effectively, which in turn can get them removed from networks.”

Big Data, in Real Time

There are powerful, individual pieces of technology supporting these performance-oriented programs, of course, but continued integration across a range of software applications is needed, according to Doyle Jensen. Jensen finds this to be the case particularly within the Medicare Part D circle of care. This may be because Part D’s star ratings are garnering a lot of attention and pharmacists are able to gauge their success through platforms such as EQuIPP. In Jensen’s view, integration is the first step in enabling pharmacies to track their success and determine where improvements are needed in their processes.

And as technology is better applied to programs that impact performance, there is going to be a greater desire for real-time access to data that will drive decisions at the point of care, according to Health Business Systems’ Spellman. “While there’s no silver bullet to the star ratings,” he explains, “one key area we hear about is real-time patient data analysis to affect healthy outcomes when the patient is in front of the pharmacist.”

Along these lines, Frank Sheppard is seeing what he calls an unprecedented value to the pharmacy’s patient population in micro-targeting patients to improve medication adherence. He sees a real need for pharmacies to be able to use big data and predictive analytics, and most importantly, the ability to have multidirectional data flow between pharmacies, other healthcare providers, and payers. In Sheppard’s view, pharmacies are going to want to be able to dissect and leverage the actionable data they can collect, which will then empower them to become top performers and leaders in a market where success is based on quality measures.

The need for real-time data extends to reporting of pharmacy performance, notes QS/1’s Michael Ziegler. “Currently, the information available online is based on data that is about six months old,” says Ziegler. “Pharmacists want to know their current star ratings, and what they can do specifically to improve them.” Ziegler further explains that QS/1 customers are solving the second half of this issue in part by looking to metrics within their pharmacy software, such as medication possession ratio, that help them evaluate and identify ways to improve adherence.

Adherence Still Top of Mind

Adherence has garnered a lot of attention over the last few years, and it has been a key stepping stone for many pharmacies as they have revved up their performance efforts and focused more and more on organized ways to improve outcomes.

Adherence is a simple concept where the difficulty is all in the details. Datascan’s Kevin Minassian notes that it is an area that continues to grow, and that pharmacies need to address it with automation that can look ahead for opportunities, not more reports that pharmacists then have to devote time to reviewing and applying. “If you want to build adherence,” he says, “a dashboard for quick viewing of issues or potential concerns is great, but the real need is for the system to auto-recognize opportunities or potential adherence issues and communicate with patients via email, text, IVR outbound dialing, and smartphone applications.” TeleManager Technologies’ Paul Kobylevsky also believes that adherence efforts will be more successful if they are easy for the pharmacist to implement as a systems user. “We are bringing to the table the ability to automate the adherence process and make it fully interactive for the pharmacy user,” says Kobylevsky. “Pharmacists should spend their time on personal communications to the patient to ensure patient loyalty and on clinical activities like medication therapy management.”

Adherence will ultimately hinge on a pharmacy’s ability to provide the right intervention to the right patient at the right time, according to Ateb’s Frank Sheppard. Sheppard sees adherence efforts, led by the transition to the appointment-based model and medication synchronization, at the center of what he calls value-based care.

Med sync, in particular, will continue to be of great interest to pharmacists as a central component of adherence programs, notes QS/1’s Michael Ziegler. The reasons for this have become increasingly clear, as more and more pharmacies move to leverage sync tools. “Having patients pick up all their medications once a month helps increase adherence, saves staff time, and helps simplify inventory management,” explains Ziegler.

And it’s almost certainly good news that the adherence trend and med sync haven’t achieved maximum impact yet, in Ziegler’s view. He points out that further gains in adherence will be made when there’s an electronic information exchange of prescriptions from the hospital discharging a patient to the pharmacy. “During a hospital visit, new medications are frequently prescribed and current medication dosages are changed,” Ziegler says.

Innovation’s Doyle Jensen offers another view on how synchronization programs will get a boost in the near future. He’s looking for pharmacies to key on not just synchronizing patient medication schedules, but also synchronizing diagnosis and therapy schedules across multiple patients within a pharmacy. “This will enable pharmacies to extend adherence support by being prepared with appropriate prescription inventory, supplemental purchases, and even store specials and training engagements for a given diagnosis and therapy regimen,” explains Jensen.

In the long-term care space the adherence trend will be toward following patients across the continuum of care, according to SoftWriters’ Heather Martin. As she notes, the LTC pharmacy service model has long rewarded expertise in med sync and packaging, and pharmacies are increasingly seeing a way to add value by helping patients take that service with them after discharge.

Automation

Dispensing automation is having an impact on pharmacies’ adherence efforts as well. First there’s the impact on that precious pharmacy commodity we addressed earlier, time. Kirby Lester’s Mike Stotz is also seeing pharmacy managers and owners, especially in smaller businesses, who are worried about the time commitment to implement and successfully manage adherence and performance programs. “We see smart, hard-working pharmacy owners falling victim to ‘project paralysis,’” he explains. Stotz notes that it’s important to remember that these programs are hefty undertakings, and pharmacy managers sometimes don’t know where to start, or how they’re going to invest enough mental energy and time. Here, automated dispensing technology can become an important support tool, because adherence and med sync fall apart without that one-on-one personal interaction.

This is likely a major contributor to a trend RxMedic’s William Humphries raised in his assessment: “Two or three years ago it was mainly larger pharmacies looking at dispensing automation,” says Humphries. “Now even the smallest pharmacies are looking at it, and we see a trend toward smaller and more affordable automation.” The scenario as he sees it is that all pharmacists are getting busier as they try to balance higher prescription volume with the need to focus more on clinical and performance-oriented opportunities. The result is that even pharmacy owners who didn’t feel they needed a full-blown automation solution in the past now know that they need something to get them the time to be in front of the patient.

The Outlook
Adherence has garnered a lot of attention over the last few years, and it has been a key stepping stone for many pharmacies as they have revved up their performance efforts.
Dispensing automation can also have an impact on adherence when it offers packaging. While, as we noted, this is traditionally a strength of pharmacies serving the longterm care market, Synergy Medical’s Kevin Combs reports now seeing a large number of retail pharmacies turning their attention to the impact packaging has on adherence and, as a result, becoming interested in solutions like multidose cards. “In the United Kingdom, 50% of all patients get their medications in multidose cards,” says Combs, “and in Canada it’s around 20%. In both of those countries they focused on adherence a few years ago, and the way they solved the problem was adherence packaging.”

But as this becomes a technology that more pharmacies are looking to add to their mix, Manchac’s Randall Murphy cautions not to expect too much, as there’s no single technology that will solve all adherence needs. “We see all types of pharmacies trying to offer adherence packaging,” notes Murphy, “and while it’s a nice thing to offer, the complexity for the pharmacy can make it very challenging.”

Increasing Access, Convenience

You can even find adherence drivers in what might seem like unexpected places, in this case point-of-sale (POS) technology. As Retail Management Solutions’ Mike Gross notes, improving patient access to medications is one of the easiest ways to increase adherence. “To this end, if pharmacies can improve customer service by offering unique services like curbside pickup, home delivery, and bedside discharge programs,” says Gross, “their patients’ adherence will increase.” And the technology to support these services is mobile POS, which has really blossomed in the last few years to the point where any pharmacy can easily have a full-fledged, handheld terminal and begin using this tool as a component of an adherence program.

What About Specialty?

Shifting gears, we wanted to look at another area of both opportunity and trepidation, and that’s specialty pharmacy. There’s a great deal at stake here, since specialty has varying definitions and different demands, depending on exactly why a drug is given this classification. At its most fundamental, specialty is high dollars and high cost of ownership, as Health Business Systems’ Marty Spellman puts it. “We have existing clients already involved in specialty today,” says Spellman, “and key solutions to support the data sharing that is necessary to maintain specialty accreditations.” Additionally, it’s critical in specialty to have the ability to gather drug-specific clinical information and report on it, according to CarePoint’s Rachel Cupp, as well as to be able to design specific care plans for patients.

Ateb’s Frank Sheppard and QS/1’s Michael Ziegler explain further. Sheppard cites the need for software to support pharmacy documentation of symptoms, side effect management, lab values, clinical consults, risk evaluation and mitigation strategy (REMS) requirements, and outcomes reporting, as well as pharmacy staff and patient education. Ziegler points out that specialty medications also require a higher level of prior authorization functionality, as well as the management and storage of more documentation. “It’s more important than ever for community pharmacy to prepare to effectively meet the needs of patients requiring specialty medications,” concludes Sheppard.

Two of the keys already covered will prove important for specialty pharmacies in 2016 as well: integration and automation. As Innovation’s Doyle Jensen sees it, pharmacies engaging in this space must have well-integrated software and hardware systems in order to effectively operate a specialty business and ensure optimal specialty care. “On the software side, we believe more robust scheduling, tracking, and proactive care functionality will increase the level of service available to patients and increase the return for these services,” Jensen says. Then with automation, packaging can once again come into play, according to Synergy Medical’s Kevin Combs. “The average specialty medication costs more,” says Combs, “and it’s imperative that the patient takes it at the right time each day as prescribed.” Both are areas in which the precision of automation and structure of packaging can have an impact. In fact, specialty pharmacy’s requirements to take outcomes-focused action and be able to prove that you had an impact offer a good lesson for any pharmacy, since they can really be seen as a more intensive version of the approach pharmacies increasingly need to apply to standard medications.

The Outlook
Dispensing automation is having an impact on pharmacies’ adherence efforts as well. First there’s the impact on that precious pharmacy commodity we addressed earlier, time.

Eye on Regulations

Amid all the operational and clinical challenges pharmacies continue to face, it’s always worth keeping an eye on the regulatory environment. Top of the list for the coming year on the pharmacy system side are e-prescribing, for controlled substances in particular, track and trace, immunization reporting to state registries, and audit demands. That being said, SoftWriters’ Heather Martin offers the opinion that regulations won’t be quite as impactful on the company’s product roadmap as will the continuing pressure on margins.

We asked for input specifically on track and trace, as this is a new set of regulations that will play out over time. These rules shouldn’t prove too burdensome to pharmacy and systems developers in the coming year, it seems. The ball is in the wholesalers’ court right now, though vendors are keeping an eye on meeting future needs such as pharmacies’ ability to manage product serialization and point out that pharmacists should expect that their pharmacy software, if it is up to date, will be able to track medications down to the lot level, and even down to the ingredient level for compounds.

On the point-of-sale side, credit card security is a major focus, since payment card data breaches are serious, potentially business-ending, events for pharmacy, according to Retail Management Solutions’ Mike Gross. Pharmacies will be working out the final transition to EMV (Europay MasterCard Visa)-certified card-processing hardware on the one hand, and should also be looking to ensure that they are protecting the data they are transmitting with point-to-point encryption. This second technology eliminates the need for a business to ever hold payment card data, with the result that there’s nothing for hackers to find should they breach security. Also on the agenda, according to ECR Software’s Ashlee Weatherman, is keeping up to date with the payment card industry data security standard (PCI DSS) requirements and supporting pharmacy pseudoephedrine (PSE) tracking and reporting needs.

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Planning for 2016

With this as background, what do the technology vendors see as the smartest investments for pharmacies in the coming year?

Many of the responses focused around three p’s, in this case process, patient engagement, and performance. Vendors anticipate that pharmacies will focus their technology investments around integrated platforms that improve workflow and afford new opportunities in data analysis and business intelligence. As one respondent put it, pharmacies should look to put their investment dollars toward cutting down on labor and paper, while enhancing quality assurance programs. All this in turn will help pharmacies raise the patient care bar, either through expanding existing programs or creating new ones. Some of the examples cited include technology that will help drive star ratings, and streamline and automate pharmacy engagement efforts with patients. These investments will be successful when they improve quality of care, address increasingly stringent star rating requirements, and help transform the pharmacy into what one respondent called a healthcare destination.

At the same time that pharmacies should look to technology for these three p’s, they will also want to focus on tools that can improve the customer experience. Suggestions here include mobile apps for convenient and easy points of contact for patients, for example when requesting refills or setting up reminders. Mobile should also be on pharmacies’ shopping list for internal operations, with both consumer- and commercial-grade portable hardware a strong choice for point of sale, signature capture, and deliveries. Cloud-based technologies ought to get a serious look, due to the ease with which pharmacies can roll out just the kinds of communications and engagement services and customer convenience tools that are being highlighted here. The cloud’s not new, of course, but trends are converging to make it a serious option for a wider and wider range of pharmacies.

And while we’re talking about investment, it’s important to note that technology vendors expect pharmacies to keep a careful eye on return on investment (ROI), focusing, for example, on smaller, more affordable dispensing automation and looking for technologies that address their most labor-intensive processes — be they dispensing, packaging, or QA — in order to tackle the fixed costs associated with these as efficiently as possible.

Keeping Up, Gaining Ground

There’s clearly plenty that pharmacies need to have on their to-do lists for 2016 if their loftiest goal is just maintaining the status quo. But if one thing is clear, it’s that the trends out there aren’t going to treat the status quo kindly. Pharmacies that have a successful 2016 and position themselves for more in 2017 will be those that grasp the complexities of the current clinical and operating environment. But just understanding what’s at stake won’t be enough, of course. What’s needed is strategic action on the part of both pharmacies and their technology vendor partners to ensure that the profession positions itself as an indispensable part of care, and that each pharmacy is carving out a well-defined place for itself. CT

Will Lockwood is VP and a senior editor at ComputerTalk. He can be reached at will@computertalk.com